Transcription of New Visa Form - Philippine Consulate General, Los Angeles
1 FA form 2-A_____ Photo 2" x 2" APPLICATION FOR NON-IMMIGRANT VISA TO THE PHILIPPINES _____20___ Surname / Family Name / Last Name CitizenshipFirst Name / Given NameMiddle Name (mother's maiden surname / if married, maiden surname)Civil StatusSingleWidowedMarriedDivorcedSepara tedOccupationEmployerAddress of EmployerDate of Birth(mm/dd/yy)Place of BirthCurrent Address in the US (Apartment No., Street,City) SexMaleFemaleStateZip CodePhone NumberName of Spouse Address of SpouseReference in the Philippines, if any. Name, AddressFinancial means of support and proofNext Port of DestinationBusinessPleasurePurpose of VisitLength and Dates of intended stayPassport CountryIssued ByExpiry Date (mm/dd/yy)Passport NumberIssued on (mm/dd/yy)Have you ever been convicted of a crime? If yes please provide detailsSUBSCRIBED AND SWORN to before me this _____ day of _____OFFICER AUTHORIZED TO ADMINISTER OATHSIGNATURE OF APPLICANTFOR OFFICIAL USE ONLYThe following people are accompanying me to the Philippines Passport Visa No.
2 _____ Granted_____ as non-immigrant under section 9( )_____. of the Philippine Immigration Act of 1940, as amended, Multiple entry until_____ Visa Includes: CONSUL OF THE REPUBLIC OF THE PHILIPPINESPRINT NAME AND SIGNATURE DATE RELEASED:FOREIGN SERVICE OF THE PHILIPPINES (Field for Embassy/ Consulate General Address and contact nos.) I solemnly swear that the foregoing statements are true to the best of my knowledge and belief.
